A Pilot Intervention Study of Health Coaching to Promote Diabetes Self-Care in the Community

Diabetes and its complications pose a substantial physical, psychological and financial
burden on the large number of racial/ethnic minorities and other socioeconomically deprived
persons with diabetes. However, self-management goals are often not met in racial/ethnic
minorities and in populations with fewer socioeconomic resources. In response, our research
team has developed a novel "health coaching" intervention to promote diabetes
self-management in the community. Health coaching is based on Control Systems Theory and
helps patients to: 1) identify problems in self-care behaviors; 2) create dynamic plans for
correcting these issues; and, 3) learn to navigate the complexities of everyday life and to
achieve clinically and personally desirable outcomes. The primary innovation of the present
project is that first-year medical students are trained to serve as the health coaches, and
are participating in the study Coaching for Control (STU00069506). The objective of our
pilot study is to test whether 20 patients from five Northwestern Medicine primary care
practice groups (two in the Austin community, two at Northwestern Memorial Hospital and one
at Norwegian American Hospital) enrolled in the "Coaching for Control" intervention
experience favorable changes in clinical and behavioral outcomes after 16 weeks as compared
with an equal number of patients from those same clinics who are not enrolled in the
program. We will use a non-randomized trial design to carry out the following aims: 1.
Determine whether patients with diabetes who participate in the "Coaching for Control"
behavioral intervention program (i.e., the intervention arm) have lower hemoglobin A1c
(HbA1c) after four months than patients who do not participate in the program (i.e., the
control arm). 2. Determine whether diabetes patients in the intervention arm report higher
task-related self-efficacy for initiating and maintaining recommended diabetes self-care
behaviors than participants in the control arm. We hypothesize that participants in the
intervention arm will have more favorable HbA1c and report higher self-efficacy for diabetes
self-care behaviors than participants in the control arm. Secondary objectives are to test
whether these changes persist 8 months after the program ends and to test whether we observe
changes in additional clinical measures such as blood pressure, waist circumference, and in
self-reported health behaviors such as medication adherence, self-care behaviors, physical
activity and diet. Process evaluations through focus groups and interviews with participants
will allow us to refine our intervention. The translational aspects of our proposal include
the application of a proven intervention to promote diabetes self-care in a community
setting that includes adults at high risk for diabetes complications. Findings from the
present pilot study will be used to justify expansion of the study to a larger group of
community members so that we can carry out a larger randomized trial of efficacy.

Inclusion Criteria:

- age > 18 years old,

- diagnosis of diabetes

- ability to read and understand English,

- access to a personal telephone,

- intent to remain in the medical practice group for at least 1 year,

- intention to remain in the Chicago, IL area or surrounding suburbs for 1 year.

- Ability to read and understand the informed consent.

Exclusion Criteria:

- primary diagnosis of gestational diabetes or type 1 diabetes

- severe mental impairment,

- primary preferred language other than English

- severe comorbidity with a life expectancy of < 1 year

- currently enrolled in another counseling-based diabetes intervention program

- prior participation in the Coaching for Control intervention development in 2012